Bringing Single Payer to Washington State

Yesterday I attended a meeting of Health Care for All Washington regarding single payer legislation in our state. The particular set of bills they are supporting are SB-5701 and HB-1026 which establish a trust fund (the Washington Health Security Trust or WHST) which would eventually act as a single payer for health care services in the state of Washington.

Specifically, this legislation creates the trust fund, establishes a board of trustees and guidance committees to run the Trust, and then lays out in very broad strokes what the Trust is meant to accomplish. As described in the legislation, the Trust is meant to pay for health care for Washington residents not otherwise covered by Medicaid, Medicare, or private insurance including dental and long term care (think nursing homes). Most likely the funds for the Trust would come from a combination of a payroll tax and a sliding-scale premium.  

Because these bills simply kick off the process of drafting legislation (e.g. hearings and committee meetings), there remain many unanswered questions about the final form of the Trust. When it comes to health policy, details matter because the people’s health is on the line and there is lots of money in play. You can bet that hospital and insurance company lobbyists are going to be very engaged in this process, so a great deal of citizen oversight will be necessary to keep legislators honest.

One major consideration is that in order to negotiate for low rates, the Trust must have flexibility in coverage. A major limitation for Medicare is that it is mandated to cover all “items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury” without consideration of cost efficacy. This greatly weakens the negotiating position of Medicare.

In order to have a strong negotiating position, the Trust must have the power to decline coverage of medications and procedures that are not cost-effective. Declining coverage of treatments risks political blowback, especially when those that profit most from these treatments start running smear campaigns. For that reason, it will be extremely important to have this legislation be bipartisan, so that coverage decisions are not politicized.

This process is likely to be difficult, and given that many of our lawmakers have shown a preference to political grandstanding over maturely crafting thoughtful legislation, I must admit a some nervousness. That being said, transitioning to a single payer system is one of the most important tasks of our generation, so we must press forward. For this reason, I will be calling my state legislators to support SB-5701 and HB-1026 to keep this process moving forward.

For more information, check out coverage in The Stranger here.



Author: Harrison Kalodimos

I'm a family medicine resident at Swedish Medical Center in Seattle.

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